New School Lessons: Eating Healthy

We hear a lot about the obesity epidemic in the United States, especially among children and adolescents. However, the impact that school meals have on childhood weight and overall health has been overlooked. A piece in the Wall Street Journal earlier this year looks at five creative ways schools can encourage students to eat more healthily. These interventions have been formulated to help schools meet the guidelines under the Healthy Hunger-Free Kids Act of 2010.


Intervention One: Product Placement

Salad bars that feature at the front, or in the center, of a school lunch line are much more likely to attract students. Some Maryland elementary schools opened all-you-can-eat salad bars that featured five different fruits and five different vegetables a day and saw the number of students buying salad go up. In fact, one study found that strategic placement of vegetable options can increase consumption by as many as five times. Other schools planned the timing of vegetable snacks, so that hungry students were more likely to reach for them before a meal.


Intervention Two: New and Improved Advertising

Changing children’s preferences can be as simple as slicing up fruits for those with orthodontic appliances, or using more colorful bins to display fruits at lunch. “Stealth nutrition,” according to the WSJ piece, can also come in the form of food names that appeal to a young crowd (e.g. “X-Ray Carrots or Turbo Tomatoes.”) Attention-grabbing cartoon stickers on fruits can also increase consumption.


Intervention Three: Tracking Real Consumption

This is an intervention that can reduce waste, and at the same time, determines which foods are popular with students and which are not.  Researchers at some Chicago elementary schools recorded what foods were purchased and thrown out in order to determine the relative popularity of certain food groups.


Such measures can also increase parental involvement: some schools send home weekly report cards that record what a child ate throughout the week, based on lunch swipe summaries. Instead of remaining in the dark about what their children eat at school, parents can talk with their children about their meals or even compensate for missing nutrients at home.


Intervention Four: Bring in the Experts

Children can’t be expected to enjoy food that adults would also avoid. Chefs can consult for school menus or cook directly in schools. Over time, partnerships with chefs and local food sources can have a big impact.


Intervention Five: Field Trip!

Nutrition education should not have to be boring. In fact, it absolutely should not be, since a child’s first impression of a food item is crucial. Some elementary schools have started taking students on field trips to local farms, teaching ways of sustainability along with familiarizing students with new fruits and vegetables. They encourage students to make note of how a fruit smells, or what color a vegetable might be.  In NYC, the Wellness in School Program encourages students to make healthy choices for themselves based on what they observe in the fresh produce and nutrition labels they encounter.


Social Incentives for a Healthy Lifestyle


A recent article in the New England Journal of Medicine argues that the infrastructure to harness healthy habits already exists within our social interactions. The support from friends and families can help us make healthy decisions on a daily basis. The article outlines five rungs of social incentives used to improve patients’ health and to test their effectiveness. Here is a short description of each of the rungs illustrated in the article:


Rung One: “Patients have no explicit social engagement.”

Since health is at once a public and a private matter, some of our most important daily health maintenance routines are invisible to the world. The authors point out that our health can be invisible even to us - without a pedometer, we don’t have a grasp of our daily activity. Realizing the correlation between self-awareness and developing healthy habits, CHIL has partnered with New York City schools to bring pedometers to students. Read more about our pedometer program.


Rung Two: Patients’ activities, outcomes, or goals are visible to others.”

In order to encourage healthy behavior, you and your family can physically partake in habits, such as taking daily medications and vitamins, in a visible place. Restaurants have started to use this model to promote handwashing by moving the sink out of the bathroom and into a more public space.


Rung Three: External support is explicitly established.”

Signing up for external support, such as text alerts, to remind you and your kids to exercise can increase healthy outcomes. For everyday challenges, such as lowering blood sugar levels, simple interventions like weekly phone calls with a mentor can be more effective than expensive drugs.


Rung Four: “Interventions leverage reciprocity.”

It’s all about being committed to a friend’s goals as well as your own regardless of your age. Even physicians are known to work in teams to competitively improve outcomes. This element of competition can certainly energize patients combatting chronic diseases such as diabetes.


Rung Five:Reputational or economic incentives are layered on top of social commitments.”

This is the ultimate goal in the five-rung model. Individuals and teams can work together to create leaderboards and competitions. By doing so, there can be an increased sense of accountability as people work together toward a reward. Patients have greater potential to succeed if teammates know each other beforehand and are introduced to incentives together.



Handwashing Day, Everyday

Every year, 1.7 million children worldwide die before the age of five from diseases like diarrhea and pneumonia, which are preventable by washing hands with soap, according to the Global Public-Private Partnership for Handwashing (PPPHW).

PPPHW started an awareness initiative called “Global Handwashing Day” - this year, it was on October 15th, 2016 - to shed light on an important, and often overlooked, health habit: hand-washing. Here at CHIL, we have even written about the importance of hand-washing, and what you can do to encourage children to develop this fundamental habit. PPPHW goes into detail to explain how the positive effects of hand-washing can spread beyond children’s health.


Hand-washing with soap kills bacteria and viruses that can cause severe illnesses from diarrhea, skin and eye infections, pneumonia and acute respiratory infections, and even Ebola. It also reduces the risk of hospital-acquired infections especially when caring for children and infants.


The surface of our hands contains millions of invisible germs that come from handling waste and food, and these germs can include E.coli and norovirus, the most common causes of diarrhea from food poisoning. Even if they don’t cause severe food poisoning, these viruses and bacteria can prohibit the proper absorption of nutrients from food. Hand-washing breaks the resulting cycle between disease and undernutrition. When children do not properly absorb nutrients from what they eat, they are more susceptible to falling sick - it’s a vicious cycle that can be broken by developing a hand-washing habit.


Effective hand-washing is a fundamental component of a child’s education and school environment. Schools rightly dedicate time teaching young students about the benefits of careful hygiene, and the results are undeniable: better school attendance and better performance in the classroom.


Hand-washing is one of the most cost-effective interventions a citizen can engage in to improve his/her health, and it is something that children can learn at a young age. Compared to interventions like improving household water supply, or investing in immunizations, hand-washing is cheaper and more effective at reducing the incidence of disease. This is especially true in developing countries but remains relevant in our communities. Hand-washing is therefore an empowering habit because it is an affordable way to maintain health.

The importance of hand-washing should not be forgotten simply because it is an elementary, simple habit to develop. Join us in setting precedence to make everyday “Hand-Washing Day.” Schools and households can improve the health of the youngest members of society by prioritizing this simple hygiene habit.